Clinical practice guidelines for the diagnosis and treatment of scabies.

Scabies, caused by the Sarcoptes scabiei var hominis mite burrowing into the skin, is a highly contagious disease characterized by intense nocturnal itching. Its global impact is considerable, affecting more than 200 million individuals annually and posing significant challenges to healthcare systems worldwide. Transmission occurs primarily through direct skin-to-skin contact, contributing to its widespread prevalence and emergence as a substantial public health concern affecting large populations. This review presents consensus-based clinical practice guidelines for diagnosing and managing scabies, developed through the fuzzy Delphi method by dermatology, parasitology, pediatrics, pharmacology, and public health experts. The presence of burrows containing adult female mites, their eggs, and excreta is the diagnostic hallmark of scabies. Definitive diagnosis typically involves direct microscopic examination of skin scrapings obtained from these burrows, although dermoscopy has become a diagnostic tool in clinical practice. Treatment modalities encompass topical agents, such as permethrin, balsam of Peru, precipitated sulfur, and benzyl benzoate. In cases where topical therapy proves inadequate or in instances of crusted scabies, oral ivermectin is recommended as a systemic treatment option. This comprehensive approach addresses the diagnostic and therapeutic challenges associated with scabies, optimizing patient care, and management outcomes.

Investigation of the effects of Toxoplasma gondii on behavioral and molecular mechanism in bradyzoite stage.

Toxoplasma gondii is a single-celled parasite that causes a disease called toxoplasmosis. It can reach the central nervous system, but the mechanism of T. gondii disrupting the functioning of these brain regions occurs in bradyzoite stage of parasite, causing brain damage by forming tissue cysts in brain. In our study, the effects of T. gondii on locomotor activity, anxiety, learning and memory, and norepinephrine (NE), levodopa (L-DOPA), dopamine (DA) and 3,4-D-dihydroxyphenylacetic acid (DOPAC) catecholamines in amygdala, striatum, prefrontal cortex and hippocampus regions of the brain were investigated in bradyzoite stage. Twenty male Albino mice Mus musculus, 4-5 weeks old, weighing 20-25 g, were used. T. gondii inoculated to mice intraperitonealy with 48-50-hour passages of T. gondii RH Ankara strain. For intraperitoneal inoculation of mice 5x104 tachyzoites per mouse. No inoculation was made in control group (n: 20). Locomotor activity behavior in open field test (OFT), anxious behavior in elevated plus maze (EPM), and learning behavior in novel object recognition (NOR) tests were evaluated. NE, L-DOPA, DA and DOPAC were measured by HPLC in brain tissues of amygdala, striatum, prefrontal cortex and hippocampus. A decrease was observed in the locomotor activity, anxiety and learning values of the T. gondii group compared to the control group (p < 0.05). The heighten in NE and L-DOPA levels in amygdala tissue of T. gondii group compared to control group, an elevation in NE, L-DOPA, DA and DOPAC levels in striatum tissue, and an increase in levels of NE in prefrontal cortex tissue were detected in monoamine results. In hippocampus tissue, an increase was observed in DA levels, while a decrease was observed in NE, L-DOPA and DOPAC levels. In our study, it has been shown that T. gondii in bradyzoite stage reduces locomotor activity, causes learning and memory impairment, and has anxiogenic effects.

Pediculicide regulations and usage trends in Türkiye in 2015-2022.

BACKGROUND: Over the years, the increasing prevalence of head lice infestation has led to an increase in treatment-related costs and the development of resistance to pediculicides. This study aimed to evaluate pediculicide sales over an 8-year period (2015-2022), including the COVID-19 pandemic. METHODS: Data on products registered in the Turkish Pharmaceutical Index Dataview, Intercontinental Medical Statistics (IMS) database, sold on prescription and approved by the Ministry of Health in Türkiye were formally requested from the research organization IQVIA for pharmacologically active pediculicides (PAP) such as permethrin, pyrethrin, and sumithrin. Data for physically active products containing dimethicone (DMT) were obtained from the relevant pharmaceutical companies. Sale revenues were determined based on sale prices in the aforementioned year. RESULTS: Total sales of pediculicides decreased from 2,452,846 units in 2015 to 2,028,840 units in 2022. While PAP consumption decreased over the years, from 1,832,006 to 518,460 units, DMT consumption increased from 620,840 to 1,510,380 units, from 2015 to 2022. The total price of pediculicides for the consumer increased more than threefold in Turkish currency. In terms of USD, an almost similar amount of money was spent over the years, with the exception of 2022 when the expenditure almost halved mainly due to the high inflation rate in the country. CONCLUSION: The decrease in PAP and the increase in DMT indicate that local lice have developed resistance to the former. Further studies are needed to determine the possible development of resistance in the country.

Importance of NK Cells in Cellular and Humoral Responses Triggered by Pneumococcus Vaccination.

INTRODUCTION: Despite the success of vaccination in reducing overall rate of pneumococcal pneumonia, Streptococcus pneumoniae is still held responsible for high mortality and modality rates worldwide. Our study aimed to investigate the potential role played by NK cells in immune response generated by pneumococcal vaccination, which could contribute to the development of more effective vaccines. METHODS: The study included mice with and without NK cell depletion which were immunized with pneumococcus polysaccharide-conjugated vaccine followed by pneumococcus polysaccharide vaccine (PPV). Serum samples and splenocytes were collected from mice sacrificed 4 weeks after the last PPV dose. Serum samples were used for antibody level quantification by ELISA assay, while splenocytes were treated with PPV in vitro before monitoring CD4+ T-cell subsets (TH1, TH2, and TH17) and cytokine (IFN-γ, IL-4, and IL-17) secretion levels by flow cytometry and ELISA analysis, respectively. RESULTS: Results demonstrated reduced pneumococcal IgG and TH1 cell levels due to NK cell depletion. Nevertheless, in contrast to these observations, IFN-γ secretion levels after in vitro PPV-23 treatment of splenocytes did not exhibit any statistically significant difference between the two mice groups. CONCLUSIONS: The data indicate a positive contribution of NK cells to both T-cell and B-cell responses triggered against pneumococcal vaccination. Further studies are required to confirm our data and investigate the potential benefit of NK cell targeting in promoting vaccine efficacy, especially in the elderly population who continues to be affected significantly by pneumococcal pneumonia.

Prevalence of Blastocystis and Dientamoeba fragilis in diarrheal patients in Corum, Türkiye.

To investigate the prevalence of Blastocystis and Dientamoeba fragilis in diarrhea patients and healthy individuals in Corum, Türkiye, fecal samples from 92 diarrhea patients and 50 healthy individuals were collected and evaluated using direct microscopy and molecular methods to screen for bacteria, protozoa, and viruses. The prevalence of Blastocystis was 24.6% in total and more frequent in the healthy group (30.0%). The commonly detected STs (subtypes) were ST3 (40.0%) and ST2 (34.2%). The distribution of Blastocystis STs in the healthy and diarrheal groups did not show any difference in sex and age, but ST3 was detected more frequently in patients aged from 40 to 59 years (p < 0.05). Alleles 4 (8/12) and 2 (4/12) were present in ST1; 9 (3/5) and 12 (2/5) in ST2; 34 (9/14), 36 (3/14), and 38 (2/14) in ST3; and only allele 42 (2/2) in ST4. D. fragilis was present in 8.4% of the population. However, there was no statistically significant difference between the healthy and diarrheic groups (12.0% and 6.5%, respectively), neither with respect to age nor sex. Co-infection was 58.3% and was more frequent in healthy individuals (33.3%) than in diarrhea patients (25.0%). Blastocystis ST3 was the most common subtype detected, with D. fragilis at 33.3%. Salmonella, Shigella, or helminth eggs were not observed in all groups, but Entamoeba histolytica, Giardia intestinalis, Cryptosporidium, Rotavirus, Adenovirus, and Clostridium difficile toxin were found only in diarrhea patients. These findings support the hypothesis that Blastocystis and D. fragilis may be part of the healthy human gut microbiome.

Impact of wars and natural disasters on emerging and re-emerging infectious diseases.

Emerging Infectious Diseases (EIDs) and Re-Emerging Infectious Diseases (REIDs) constitute significant health problems and are becoming of major importance. Up to 75% of EIDs and REIDs have zoonotic origin. Several factors such as the destruction of natural habitats leading humans and animals to live in close proximity, ecological changes due to natural disasters, population migration resulting from war or conflict, interruption or decrease in disease prevention programs, and insufficient vector control applications and sanitation are involved in disease emergence and distribution. War and natural disasters have a great impact on the emergence/re-emergence of diseases in the population. According to a World Bank estimation, two billion people are living in poverty and fragility situations. Wars destroy health systems and infrastructure, curtail existing disease control programs, and cause population movement leading to an increase in exposure to health risks and favor the emergence of infectious diseases. A total of 432 catastrophic cases associated with natural disasters were recorded globally in 2021. Natural disasters increase the risk of EID and REID outbreaks by damaging infrastructure and leading to displacement of populations. A Generic National Action Plan covering risk assessment, mechanism for action, determination of roles and responsibilities of each sector, the establishment of a coordination mechanism, etc. should be developed.

Scientometric Evaluation of the Itch Mite, Sarcoptes scabiei (Acari: Sarcoptidae): The Last Four Decades of Global Academic Output on Scabies.

OBJECTIVE: Scabiosis, the infestation of the skin with Sarcoptes scabiei, is a neglected tropical disease, with at least 200 million people being infested with the parasite at any time. It is estimated that scabies is responsible for 0.07% of the total burden of disease worldwide. Objective of this study is to perform a scientometric analysis of S. scabiei literature using the Web of Science Core Collection database for the years 1981-2020. METHODS: All documents indexed between 1981 and 2020 in scabies literature were analyzed by using a search string including keywords of "scabies", "Sarcoptes scabiei" and "S. scabiei" in Web of Science Core Collection database. We excluded all materials including data on the bacterium species named Streptomyces scabies and Streptomyces scabiei. RESULTS: Overall, 2,933 articles were retrieved on scabies, 66.3% of which were original article. With 663 publications the USA was the most productive country, while The International Journal of Dermatology was the journal with the highest number of publications on scabies. Half of the most productive institutions and seven of the top ten prolific authors were also from Australia. The National Health and Medical Research Council of Australia was the most supportive funding agency. With 4,706 citations, 2020 was the year with most references on scabies. The most cited publication was "The Global Burden of Skin Disease in 2010: An Analysis of the Prevalence and Impact of Skin Conditions" by Hay et al. in the Journal of Investigative Dermatology with a total of 565 citations. The most collaborative country was Australia and the most cooperative institution was the University of Melbourne. CONCLUSION: The majority of the studies were done in a given country while multicenter studies are very rare. It is recommended that more studies should be conducted on scabiosis in developing countries where the problem of scabies is the biggest.

[Outbreaks Due to Parasites: Examples from the World and Türkiye]. / Parazitlerden Kaynaklanan Salginlar: Dünyadan ve Türkiye'den Örnekler.

Outbreaks due to parasites can occur in various parts of the world and in different periods. These outbreaks can be caused by water and food, as well as by human-to-human or vector-borne transmission. Cryptosporidium spp. and Giardia intestinalis were among the pathogens that affected most people in water-borne outbreaks occurred in the world between 2010-2014. The chlorine resistance of both Cryptosporidium spp. and Giardia spp. leads to the widespread detection of these parasites in waterborne outbreaks. These two protozoans cause self-limiting watery diarrhea in immunocompetent individuals, but they can also cause chronic disease in certain situations. Apart from this, parasites such as Cyclospora spp., Cryptosporidium spp., Giardia intestinalis, Trichinella spp. and Toxoplasma gondii can also cause foodborne outbreaks. In Türkiye, outbreaks related to these parasites have emerged with the neglect of the notification. Some parasites transmitted from person to person can also pose a threat to public health in certain periods. Head lice, the most common examples of such parasites, can cause outbreaks in certain periods. Another example for human-induced parasitic outbreaks is scabies. There has been an increase in scabies rates in the world and in Türkiye, especially due to the Coronavirus disease-2019 (COVID-19) pandemic. In the first period of the pandemic, it was thought that due to the curfew restrictions, family members spending time at home might have led to an increase in the rate of scabies. On the other hand, as a result of the disruption of services due to COVID-19, the cases of malaria, a vector-borne disease, and the resulting deaths increased in 2020 compared to 2019 in the world. Although only imported malaria cases are detected in Türkiye today, there is a potential for an outbreak to occur at any time due to the presence of malaria vectors. An outbreak of imported malaria occurred in Mardin in 2012 due to a lorry driver entering the country from an endemic region. Immigrants that reside in Türkiye pose a risk for some infectious diseases due to the circumstances during migration or the conditions in their living areas. Leishmaniasis, which maintains its importance in the Mediterranean region, is another vector-borne disease and can be detected in Türkiye, especially in regions where immigrants reside. Bed bug infestations, which have increased recently, also closely affect the provision of health services. It is important to implement regular inspections in regions with outbreak potential, and to ensure the continuity of hygiene conditions and health services to prevent a possible outbreak. In case of an outbreak, different centers should cooperate, health authorities and academics should act together, patients and their contacts should be identified quickly and necessary precautions should be taken, the society should be informed and the outbreak should be taken under control in a short time. In this review article, outbreaks caused by parasites were examined under four headings as water, food, human and vector/arthropod-borne and examples from the world and Türkiye were given for these outbreaks.

Detection of Blastocystis Subtypes in Children with Functional Abdominal Pain and Celiac Disease in Çorum, Turkey.

Background: Blastocystis has been associated with various symptoms of the gastrointestinal tract. We aimed to investigate the prevalence of Blastocystis in children with celiac disease (CeD) or functional abdominal pain (FAP) and to evaluate its subtypes (STs) with respect to demographic, socioeconomic and epidemiological factors. Methods: Overall, 161 fecal samples were collected from healthy children and patients with FAP or CeD in Hitit University Erol Olçok Research and Training Hospital, Corum, Turkey between 2016-2018. Samples were examined using both native-Lugol (NL) and trichrome-stained (TS) smears, and further analyses by PCR and Sanger sequencing were performed. A standard questionnaire was applied to obtain demographic, socioeconomic, epidemiological data. Results: Blastocystis was found in 10.6% of the total study population. Neither bacteria nor any other parasites were found, except for one Giardia (0.6%) in the CeD group. The presence/absence of the parasite was not found to be associated with demographic, socioeconomic and epidemiological factors. Blastocysis was detected in 11.5% (6/52) of the CeD, 7.7% (4/52) of the FAP, and 12.3% (7/57) of the healthy group. Diagnostic methods were similar in terms of Blastocystis detection (P= 0.671), and there was fair agreement between the NL, TS and PCR (Fleiss' Kappa=0.847, P=0.001). ST2 (42.8%) and ST3 (35.7%) were the predominant STs followed by ST1 (21.4%). Conclusion: We observed no difference between study groups in terms of Blastocystis prevalence. ST1, ST2 and ST3 subtypes were detected. Blastocystis prevalence and STs were not related to any of the demographic, socioeconomic and epidemiological factors.

Pathogens in ticks collected in Israel: II. Bacteria and protozoa found in Rhipicephalus sanguineus sensu lato and Rhipicephalus turanicus.

Rhipicephalus sanguineus sensu lato and Rhipicephalus turanicus are very prevalent in Israel and are known to be vectors of human and animal diseases. The aim of this study was to identify the pathogens found in questing ticks and such parasitizing domestic and wild animals. Ticks were collected from 16 localities in Israel with the flagging technique and by examining dogs, hedgehogs, a badger and a tortoise. Bacterial and protozoal pathogens were analyzed by PCR and sequencing. Overall, 374 R. sanguineus s.l. specimens were collected, out of which 142 by flagging and 132 from six dogs. Rickettsia africae, Rickettsia massiliae, Rickettsia conorii subsp. israelensis, and Anaplasma sp. were identified in ticks collected by flagging, Rickettsia aeschlimannii was found only in specimens collected from dogs, while Ehrlichia sp., Coxiella burnetii, Hepatozoon canis and Leishmania infantum were recorded in ticks collected by flagging and from dogs. Out of 226 specimens of R. turanicus, 124 were collected by flagging, while additional 33 from eight dogs, 64 from seven southern white-breasted hedgehogs (Erinaceus concolor), two from a European badger (Meles meles) and one from a Greek tortoise (Testudo graeca). Out of 65 R. sanguineus s.l. pools 17 (26.2%) had pathogens, while seven of them were positive for one pathogen, and 10 for two pathogens. In 43 R. turanicus pools, R. aeschlimannii R. africae, Rickettsia barbariae, R. massiliae, Anaplasma sp., Ehrlichia sp. and C. burnetii, as well as Babesia microti, B. vogeli, Hepatozoon felis, and L. infantum was detected, while Listeria monocytogenes, Bartonella sp. and Toxoplasma gondii were negative in all R. sanguineus s.l. and R. turanicus pools examined. In conclusion, Babesia microti is reported for the first time in Israel, R. africae, R. aeschlimannii, C. burnetii and L. infantum are reported for the first time in R. sanguineus s.l. and R. turanicus, while H. felis is reported for the first time from R. turanicus in the country.

[Factors Influencing Pneumococcal Vaccination-Induced Total IgG, IgG2, and IgA Levels in Vaccinated Splenectomized Patients]. / Asili Splenektomili Hastalarda Pnömokok Asisi ile Indüklenmis Total IgG, IgG2 ve IgA Düzeylerini Etkileyen Faktörler.

Splenectomy is closely associated with a lifetime risk of pneumococcal and other encapsulated bacterial infections. In this study, it was aimed to investigate the change of antibody levels after vaccination against Streptococcus pneumoniae according to age, gender, years after splenectomy and the possible effect of splenectomy on IgG avidity. In addition the education and awareness levels of the participants about post-splenectomy vaccination and infectious diseases were also analyzed. In the first of the three phases of this study, 32 individuals with splenectomy were enrolled. The awareness of the patients about the possible risks after splenectomy was investigated with a simple questionnaire. Routine laboratory test results were obtained and clinical examinations were performed. In the second stage, total Ig values of 29 splenectomy patients were determined. In the third phase, 14 splenectomy and 5 healthy volunteers were vaccinated according to the Vaccination Practices Advisory Committee (ACIP) guidelines. Pneumococcal-specific antibody levels and IgG avidity were detected by enzyme linked immunosorbent assay (ELISA). It was determined that 68.8% of the splenectomized patients were unaware of their vaccination status and 78.2% of them were unaware of the increased risk of infectious diseases in asplenic conditions. . According to the hospital information management system, all 31 (96.87%) patients, except one, were vaccinated with PPV23. As expected, vaccinated patients exhibited high levels of vaccine-specific antibody production with IgG, IgG2, and IgA antibody concentrations of 321 ± 76.68 mg/l, 73.07 ± 8.273 mg/l, and 117.8 ± 14.94 mg/l, respectively, but unvaccinated patients had very low antibody (IgG, IgG2 and IgA antibody concentrations were 11.5 mg/l, 1.3 mg/l and 1.2 mg/l, respectively) levels. Although there was no correlation between antibody titers and gender, age groups or presence of fever history, the decrease in total IgG, IgG2 and IgA titers were strongly correlated with the time since splenectomy. Antibody titers were found to be significantly lower in splenectomized patients vaccinated more than 10 years ago. Routine laboratory results were at normal levels except for low platelet count. On the other hand, both splenectomized and healthy control subjects displayed similar IgG avidity index values (%61.8 ve %64.4% inhibition in control and splenectomized subjects, respectively) after the vaccination schedule. It was shown that post-splenectomy vaccination with PPV23 induced high levels of pneumococcus-specific antibody production that can last for more than five years. It was determined that more efforts should be made to increase the level of knowledge about pneumococcal and other overwhelming post-splenectomy infections (OPSI) as the awareness of the patients about the risks of infection after splenectomy was poor. In particular, patients with splenectomy operation more than 10 years ago should be very careful about being asplenic as they were determined to have significantly lower level of vaccine-specific antibody production. Our study was also the first to show that splenectomy does not alter IgG avidity induced by pneumococcal vaccination.

Immune mechanisms in human Sarcoptes scabiei (Acari: Sarcoptidae) infestations.

Scabies is a parasitic infestation of human and animal skin caused by different strains of the itch mite, Sarcoptes scabiei. The World Health Organization (WHO) has declared scabies in human as a neglected tropical disease, and today over 200 million people worldwide are affected. The two most commonly reported clinical manifestation of the condition are ordinary (OS) and crusted scabies (CS). CS, which can lead to fatal consequences due to secondary bacterial infections, is mostly observed in immunocompromised subjects but can also, although rarely, be detected in immunocompetent individuals. Innate and adaptive immune system components are involved in protection and pathogenesis of scabies, although with some differences between OS and CS. While the cutaneous immune response is dominated by CD4+ T-cells in OS, it is mainly mediated by CD8+ T-cells in CS. The two clinical conditions also differ in CD4+ T-cell-mediated immune responses with mixed TH 1/TH 2 (protective) and TH 2/TH 17 (non-protective) immunoprofiles in OS and CS, respectively. Moreover, the development of CS is associated with early immunosuppression that is followed by deleterious immune response to uncontrolled mite proliferation. However, the immune response to scabies still needs further attention due to inconsistent results in the literature. The aim of this study is to attract more attention to this area by summarizing the current literature on innate and adaptive immune responses triggered against S. scabiei mites.

Pathogens in ticks collected in Israel: I. Bacteria and protozoa in Hyalomma aegyptium and Hyalomma dromedarii collected from tortoises and camels.

Ticks were collected from 30 Greek tortoise (Testudo graeca), and 10 Arabian camels (dromedary) (Camelus dromedarius) in Israel. All those collected from Greek tortoises belonged to Hyalomma aegyptium, while all specimens collected from the camels belonged to Hyalomma dromedarii. Out of 84 specimens of H. aegyptium, 31 pools were examined by PCR, while from 75 H. dromedarii specimens nine pools were studied. Out of 31 pools of H. aegyptium 26 were positive for pathogens or endosymbiont; 14 for one, 11 for two and one for three pathogens. Out of nine pools prepared from H. dromedarii, seven were positive for pathogens (two for C. burnetii and five for Leishmania infantum). In H. aegyptium, Rickettsia africae, Rickettsia aeschlimannii, Rickettsia endosymbiont, Coxiella burnetii, Hemolivia mauritanica, Babesia microti, Theileria sp., and Leishmania infantum was detected, while in H. dromedarii C. burnetii and L. infantum were found. None of the ticks were positive for Anaplasma/Ehrlichia, Listeria monocytogenes, Bartonella spp., Hepatozoon spp. and Toxoplasma gondii. H Rickettsia endosymbionts, C. burnetii, B. microti, Theileria sp. and L. infantum are reported for the first time in H. aegyptium, and C. burnetii and L. infantum for the first time in H. dromedarii.

Evaluation of Formalin-fixed Paraffin-embedded Tissue Samples Diagnosed by Histopathology as Echinococcus in Çorum

Objective: This study aimed to detect the presence of Echinococcus spp. in formalin-fixed paraffin-embedded (FFPG) samples of hydatid cyst cases and to discuss the DNA isolation problems in FFPG samples. Methods: FFPG samples of 47 cases diagnosed with hydatid cyst were included in this study. Demographic characteristics of the cases were investigated. Microtome sections were taken from the samples and deparaffinization, DNA extraction, polymerase chain reaction (PCR), and gel agarose electrophoresis procedures were performed. Results: Of the cases, 55.3% were female, whereas 45.7% were male. Average age was 45.47 and 68.1% of the cases were located in the liver, 17.0% in the lung, 12.8% in the abdomen, and 2.1% in the brain. DNA was obtained in only 11 (23.4%) of the FFPG cyst samples and no proliferation was detected in the PCR products of any of the sample. Conclusion: The scolex/germinal membrane' absence in the FFPG sections, intense inflammatory cell reaction, presence of fibrosis and stromal/parenchymal tissue, DNA damage due to formaldehyde action, long-term archiving, and insufficient amount of DNA obtained were considered as factors preventing DNA replication in PCR.

Investigation of neglected protists Blastocystis sp. and Dientamoeba fragilis in immunocompetent and immunodeficient diarrheal patients using both conventional and molecular methods.

INTRODUCTION: The clinical significance of Blastocystis sp. and Dientamoeba fragilis in patients with gastrointestinal symptoms is a controversial issue. Since the pathogenicity of these protists has not been fully elucidated, testing for these organisms is not routinely pursued by most laboratories and clinicians. Thus, the prevalence of these organisms and the subtypes of Blastocystis sp. in human patients in Turkey are not well characterized. This study aimed to determine the prevalence of Blastocystis sp. and D. fragilis in the diarrheic stool samples of immunodeficient and immunocompetent patients using conventional and molecular methods and to identify Blastocystis sp. subtypes using next generation sequencing. MATERIAL AND METHODS: Individual stool specimens were collected from 245 immunodeficient and 193 immunocompetent diarrheic patients between March 2017 and December 2019 at the Gazi University Training and Research Hospital in Ankara, Turkey. Samples were screened for Blastocystis sp. and D. fragilis by conventional and molecular methods. Molecular detection of both protists was achieved by separate qPCRs targeting a partial fragment of the SSU rRNA gene. Next generation sequencing was used to identify Blastocystis sp. subtypes. RESULTS: The prevalence of Blastocystis sp. and D. fragilis was 16.7% and 11.9%, respectively as measured by qPCR. The prevalence of Blastocystis sp. and D. fragilis was lower in immunodeficient patients (12.7% and 10.6%, respectively) compared to immunocompetent patients (21.8% and 13.5%, respectively). Five Blastocystis sp. subtypes were identified and the following subtype distribution was observed: ST3 54.4% (n = 37), ST2 16.2% (n = 11), ST1 4.4% (n = 3), ST6 2.9% (n = 2), ST4 1.5% (n = 1), ST2/ST3 11.8% (n = 8) and ST1/ST3 8.8% (n = 6). There was no statistically significant difference in the distribution of Blastocystis sp. subtypes between immunocompetent and immunodeficient patients. CONCLUSION AND RECOMMENDATION: Our findings demonstrated that Blastocystis sp. and D. fragilis are commonly present in immunocompetent and immunodeficient patients with diarrhea. This study is the first to use next generation sequencing to address the presence of Blastocystis sp. mixed subtypes and intra-subtype variability in clinical samples in Turkey.

International recommendations for an effective control of head louse infestations.

Head louse infestations continue to be a concern of public health in most countries, including the most developed ones. The present recommendations are intended to inform and stress the role and impact of the different authorities, institutions, industry, and the public in the control of head lice in order to reduce the prevalence of this parasite. We encourage health authorities to pursue more effective methods to correctly identify such infestations, and evaluate existing and new pediculicides, medical devices, louse repellents, and louse- and nit-removal remedies. Pediculicides and medical devices must have verifiable claims in the instructions for use and should be tested periodically to document current levels of resistance by lice to the active ingredients and to the formulated products. Where the prevalence of lice is claimed to be epidemic, children should be periodically evaluated objectively to document the actual level of prevalence. Continuing education for health providers and the general population promises to correct misinformation regarding the biology, prevention, and management of lice. Parents should regularly inspect their children for head lice and treat as necessary. Health authorities are encouraged to eliminate policies and practices that rely upon school exclusion as a means to reduce incidence and prevalence, e.g., the 'no-nit' policy which lacks scientific justification, and are counterproductive to the health and welfare of children.

Sources and seroprevalence of toxocariasis in Turkey.

Toxocariasis in humans is considered a rare disease in Turkey, and the absence of specific symptoms of this disease is probably the main reason for clinicians to underestimate and underdiagnose the disease. Although there are several seroepidemiological studies on visceral larva migrans in the country, a comparison between them is difficult as the serological tests are not standardised. After the introduction of the easily accessible ELISA kit in the market, the number of seroepidemiological studies has increased in which the reported rates ranged between 1% and 56%. Similar to other countries, Toxocara seropositivity in Turkey is more common in men, childhood, in those living in rural area, having a low income level, owning dogs, and biting their nails or practicing geophagia. In addition, toxocariasis is a risk factor for veterinarians, farmers, and pet-shop workers. Toxocara seroprevalence is significantly higher in respiratory, neuropsychiatric, musculoskeletal, skin and abdominal disorders. There are also many studies showing the importance of eosinophilia in toxocariasis. In conclusion, although there are many studies on toxocariasis in Turkey, it is still not well understood to what extent the infection is responsible for a plethora ascribed symptoms. Standardisation of the diagnostic methods and the use of molecular techniques could further throw light in the real epidemiology and the role played by the infection to induce signs and symptoms.

Bacterial and protozoan agents found in Hyalomma aegyptium (L., 1758) (Ixodida: Ixodidae) collected from Testudo graeca L., 1758 (Reptilia: Testudines) in Corum Province of Turkey.

Hyalomma aegyptium (L., 1758) (Ixodida: Ixodidae) is a hard tick and the main host for adults are Palearctic tortoises of the genus Testudo, while larvae and nymphs are less host-specific and nymphs also attach to humans. In the present study, a total of 261 H. aegyptium ticks were removed from 26 Testudo graeca L., 1758 in Corum Province of Turkey. The most prevalent pathogens identified molecularly in the ticks were Hemolivia mauritanica (51.9 %), followed by Rickettsia aeschlimannii (32.6 %), Ehrlichia spp. (30.2 %), and Bartonella bovis (0.8 %). All samples were negative for Coxiella burnetii, Francisella tularensis, Anaplasma phagocytophilum, Babesia spp., Hepatozoon spp. and Theileria spp. Overall, 97.4 % of the examined adult ticks and 26.3 % of nymphs were infected with at least one pathogen, while 40.9 % of all ticks were infected with only one pathogen, 27.4 % with two pathogens, and 9.9 % with three pathogens, concomitantly. Overall, 80.8 % of the examined blood smears of tortoises were H. mauritanica-positive, and the mean intensity of parasitemia was 4.8 % (1-21). As a conclusion, since the examined tortoises were sampled in gardens and vineyards close to human habitation, and as a relatively large percentage of them were infested with ticks carrying pathogenic agents affecting also humans, the importance of tortoises, their ticks and pathogens in terms of the public health should be farther examined.

Thiol-disulfide homeostasis in children with celiac disease.

BACKGROUND: Toxic gliadin peptide damages enterocytes in celiac disease by causing oxidative stress. Thiols are organic compounds that defend against oxidative stress. This study aimed to investigate the changes in thiol-disulfide homeostasis in children with celiac disease. METHODS: The study included patients with celiac disease, children diagnosed with functional gastrointestinal disorders, and healthy children. Patients' serum native and total thiol-disulfide amounts, disulfide/total thiol percentage ratios, disulfide / native thiol percentage ratios, and native thiol/total thiol percentage ratios were measured. RESULTS: The study involved 172 children, of whom 90 (52.3%) were girls. The mean participant age was 8.6 ± 4.2 years. A total of 59 (34.3%) children had celiac disease, 56 (32.6%) had functional gastrointestinal disorders, and 57 (33.1%) were healthy. The total thiol and disulfide levels of patients with celiac disease (305 ± 87 µmol/L and 25 ± 15 µmol/L, respectively) were significantly lower than those of healthy children (349 ± 82 µmol/L and 40 ± 15 µmol/L, respectively) (P = 0.006 and P < 0.001, respectively). Native and total thiol levels (226 ± 85 µmol/L and 279 ± 99 µmol/L, respectively) in patients with celiac disease who consumed a gluten-containing diet were significantly lower than those of patients who consumed a gluten-free diet (278 ± 64 µmol/L and 327 ± 69 µmol/L, respectively) (P = 0.017 and P = 0.041, respectively). CONCLUSIONS: Thiol-disulfide homeostasis, an important antioxidant defense component of the gastrointestinal system, is disrupted in children with celiac disease. A gluten-free diet helped partially ameliorate this decline.

Serological screening of West Nile virus among blood donors in northern Cyprus.

BACKGROUND: West Nile virus (WNV) is a neurotropic arbovirus that can also be transmitted through blood transfusion. Even though its geographic distribution has been expanding, there has not yet been any epidemiological data on WNV in northern Cyprus. The aim of our study is to fill this gap by using donated blood samples. METHODS: Samples collected from the main government hospital blood bank in Nicosia were analyzed by anti-WNV enzyme-linked immunosorbent assay (ELISA) (immunoglobulin M [IgM] and immunoglobulin G [IgG]). Seropositive samples were subjected to plaque reduction neutralization test (PRNT) for confirmation and analyzed by ELISA IgG avidity test and reverse transcription real-time polymerase chain reaction (rRT-PCR). RESULTS: Of the 760 sera samples, 2 (0.3%) were IgM+ and 31 (4.1%) were IgG+. Neutralization activity was detected in none (0.0%) of the IgM+ and 26 (83.9%) of IgG+ donor specimens. ELISA IgG avidity test reported high avidity in 21 (67.7%) and low avidity in one (3.2%) IgG+ sample. PRNT-confirmed anti-WNV IgG+ samples exhibited only borderline (19.2%) or high avidity (80.8%) values. rRT-PCR results were negative for both IgM+ and IgG+ samples. CONCLUSION: Anti-WNV antibodies were detected in northern Cyprus among blood donors. The establishment of preventive measures and evaluation of the geographic extent of the WNV in northern Cyprus are highly recommended.